Intended for healthcare professionals


Systems for emergency care

BMJ 2000; 320 doi: (Published 08 April 2000) Cite this as: BMJ 2000;320:955

Integrating the components is the challenge

  1. Jon Nicholl, professor of health services research (,
  2. James Munro, clinical senior lecturer in epidemiology
  1. Medical Care Research Unit, University of Sheffield, Sheffield S1 4DA

    The British government's announcement of the first 36 new NHS “walk in centres” is the latest in a series of important changes in the provision of immediate access services over the past 20 years.1 A study of first contact out of hours care in England 16 years ago recorded only attendances at accident and emergency departments, general practitioners' home visits and telephone advice, and visits by deputising services.2 Contacts with regional trauma centres, minor injury units, general practitioners' out of hours cooperative treatment centres, community pharmacies, and community mental health teams, for example, were either negligible or non-existent.

    The recent development of triage and advice telephone services, such as NHS Direct,3 has further complicated the picture, and now the government proposes 36 walk in centres (with more under consideration) to “offer a service to the public, when the public need it and where the public need it.”1 These services, based in shops, health centres, and hospitals will be nurse led, with access to general practitioners in some cases, and will offer extended opening hours, including evenings and weekends—but how do they fit into the changing …

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